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C Del Mar Analytical <br /> 852 Aunn A,e I—e CA 92 714 17111,61 1022 FAX{1141 261 121& 57474 <br /> 1014E e,Or S,le A Conou CA 97 S74 19091 570 4667 FAX 19091 370 1046 <br /> 16525 Shennsn Way Suite C I 1 Van Nuys CA 91406 117181 719 1844 {AX 1818]779 1843 <br /> 2465 W 121h St Swte t Tempe AZ 85281 $021969 82 17 FAX 16021 968 13 38 <br /> CHAIN OF CUSTODY FORM <br /> Client Name/Address Protect/PO Number i <br /> l N TI-Kti q-f,u\AL U -��. , S ic <br /> oClc,7on1 Analysis Required <br /> �J t l N i , A0Z I'ZLNa 2 � t i L5:N WIAF- P <br /> 7cclProtect Manager/Phone Number Sampler <br /> pE� M l,i-Q-n+ <br /> (V4Hr,/ uZI .1orin1 v in <br /> Sample Sample Container #of Sampling Preservatives <br /> Description Matrix Type Cont Date/Time ,� Special Instructions <br /> �IGmt.+ <br /> (`A d-2 <br /> N 2 ct <br /> at 2 <br /> Relinqui d By Date/Time f y / Receive b 42� Da /Time Turnaround Time Icheck) <br /> same day 72 hours <br /> Relinquished By Date)Time Rece y Date /Time 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date(Time R cel n ab b Date /Time Sample Integr (Check) <br /> aml Intact on is <br /> _Sa 1 I sed Mr:30 _ <br />